{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:49:56Z","timestamp":1776275396229,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":104,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,3,5]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal surgical strategy for mitral valve (MV) infective endocarditis (IE) remains uncertain. Although valve repair is increasingly advocated, MV replacement is frequently performed, and robust data comparing long-term outcomes between approaches are limited. We evaluated long-term survival following MV repair vs replacement in patients with IE-related mitral regurgitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 88 consecutive patients who underwent MV surgery for IE-associated mitral regurgitation at St George\u2019s Hospital NHS Foundation Trust, UK, between June 2011 and May 2025. Long-term all-cause mortality was assessed using Kaplan-Meier survival analysis. Multivariable logistic regression identified independent predictors of mortality, and model discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort comprised 65% men with a median age of 57 years (IQR 44.0\u201364.8). MV replacement was performed in 51.1% of patients who were older than those undergoing repair (median age 62 vs 51 years). In-hospital mortality was 4.5% and long-term all-cause mortality was 14.8%. No in-hospital deaths occurred in the repair group. In age-adjusted and sex-adjusted analyses among replacement patients, increasing age (OR 1.1; 95%\u2009CI 1.0 to 1.1; p=0.03) and diabetes mellitus (OR 7.8; 95%\u2009CI 1.3 to 48.8; p=0.02) independently predicted long-term mortality. The model demonstrated good discrimination (AUROC 0.83; 95%\u2009CI 0.69 to 0.97). Mean survival was significantly longer following repair than replacement (161.0 vs 129.9 months; p=0.008).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MV repair for infective endocarditis is safe and associated with superior long-term survival compared with replacement. Diabetes mellitus is a strong independent predictor of mortality in the MV replacement group, highlighting the importance of risk stratification in surgical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004008","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:55:19Z","timestamp":1776272119000},"page":"e004008","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes of mitral valve surgery in infective endocarditis: a single-centre UK experience"],"prefix":"10.1136","volume":"13","author":[{"given":"Aziz","family":"Momin","sequence":"first","affiliation":[{"name":"1Department of Cardiac Surgery, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-5023","authenticated-orcid":false,"given":"Redoy","family":"Ranjan","sequence":"additional","affiliation":[{"name":"1Department of Cardiac Surgery, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"},{"name":"Department of Cardiothoracic surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Sowden","sequence":"additional","affiliation":[{"name":"1Department of Cardiac Surgery, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazin","family":"Sarsam","sequence":"additional","affiliation":[{"name":"1Department of Cardiac Surgery, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkatachalam","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"1Department of Cardiac Surgery, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026041509551105000_13.1.e004008.1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.amjcard.2025.02.023","article-title":"Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies","volume":"244","author":"Tzoumas","year":"2025","journal-title":"Am J Cardiol"},{"key":"2026041509551105000_13.1.e004008.2","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.mayocp.2015.12.006","article-title":"Incidence and Predictors of Infective Endocarditis in Mitral Valve Prolapse: A 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repair and long-term risk of infective endocarditis: a Danish nationwide study","volume":"46","author":"Alhakak","year":"2025","journal-title":"Eur Heart J"},{"key":"2026041509551105000_13.1.e004008.7","doi-asserted-by":"crossref","DOI":"10.1111\/eci.13577","article-title":"Infective endocarditis and outcomes of mitral valve replacement","volume":"51","author":"Anttila","year":"2021","journal-title":"Eur J Clin Investig"},{"key":"2026041509551105000_13.1.e004008.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-025-22100-z","article-title":"Global, regional, and national burden of infective endocarditis from 2010 to 2021 and predictions for the next five years: results from the Global Burden of Disease Study 2021","volume":"25","author":"Lin","year":"2025","journal-title":"BMC Public Health"},{"key":"2026041509551105000_13.1.e004008.9","doi-asserted-by":"crossref","DOI":"10.3390\/metabo12080682","article-title":"Infective Endocarditis in High-Income 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